NAVMC 118(11) - Administrative Remarks .2015-10-27  Title: NAVMC 118(11) - Administrative Remarks

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    I have been counseled concerning SBP and fully

    understand the automatic enrollment and future

    enrollment provisions on the Plan.



    Articles UCMJ explained to me this date as

    required by Article 137, UCMJ.

    Articles UCMJ explained to me this date as

    required by Article 137, UCMJ.

    Adobe LiveCycle Designer 9

    NAVMC 118(11) (REV. 05-2014) (EF)


    FOUO - Privacy sensitive when filled in

    Ver 3.0



    Redsigned to include electronic signatures per MI; SSN field revised toenterfull SSN per MI

    USMC Forms Mgr

    NAVMC 118(11) - Administrative Remarks



    Enter YYYY-MM-DD: SignatureField1: Enter YYYY-MM-DD: Enter YYYY-MM-DD: NameLFM: Enter EDIPI/DODID: Remarks1: Not Physically Qualified (NPQ) Placement

    _______ I have been notified this date that I am being placed in an (Initials) NPQ status due to a non-service related medical condition or injury. As a member of the United States Marine Corps Reserve, I am expected to maintain good physical health per DoDI 6025.19.

    _______ According to MCO 1001R.1K, I am not (Initials) authorized to perform Inactive Duty Training (IDT), Annual Training (AT), Additional Duty Training (ADT), Inactive Duty Training Travel (IDTT), or Active Duty for Special Work (ADSW) while in an NPQ status.

    _______ I understand that while I am in an NPQ status, I must (Initials) provide the Medical Department Inspector-Instructor medical documentation, at a minimum, every 30 days from my physician. Failure to provide required documentation could result in administrative actions, including, but not restricted to, administrative separation and/or (for enlisted personnel) reduction in grade per Marin Corps 10001R.1K

    Member's Contact Information:

    Home Address:Phone Number:Email:

    ______________________ _____________________ _________ (Member's Printed Name) (Member's Signature) (Date)

    ______________________ _____________________ _________ (CO/I-I Printed Name) (CO/I-I Signature) (Date)Remarks2: _11: ResetButton1: PrintButton1: